Varney's Ch. 5: Common Conditions in Primary Care

Question 1

What is the level of Hgb that is diagnostic for anemia?

Answer 1

<12.0 g/dL (women)

Question 2

What types of anemias are considered NORMOLITIC anemia?

Answer 2

1. acute blood loss
2. autoimmune disease
3. sickle cell

Question 3

What types of anemias are considered MICROLYTIC anemia?

Answer 3

1. iron deficiency
2. thalassemia
3. anemia of chronic disease

Question 4

What types of anemias are considered MACROLYTIC anemia?

Answer 4

1. folate deficiency
2. vitamin B deficiency

Question 5

What type of anemia will have a high TIBC (total iron binding capacity)?
1. folate deficiency
2. iron deficiency
3. vitamin B12 deficiency
4. sickle cell anemia

Answer 5

2. Iron deficiency anemia

Question 6

What ferritin level is diagnostic of iron-deficiency anemia?

Answer 6

<100-150 ng/mL

Question 7

What are iron-rich foods?

Answer 7

1. green leafy vegetables
2. egg yolks
3. raisins or prunes
4. liver or oysters

Question 8

What is the recommended dose for correcting iron-deficiency anemia?

Answer 8

325 mg ferrous sulfate daily.

Question 9

How can the daily iron supplementation be adjusted to decrease side effects?

Answer 9

every-other-day dosing

Question 10

What medication should be avoided when taking iron?

Answer 10

antacids - decrease absorption

Question 11

After iron levels have been normalized, how much longer is supplementation recommended to adequately replenish iron stores?

Answer 11

3 months.

Question 12

Is the MCV high or low in macrocytic anemia?

Answer 12

high

Question 13

What ethnicities are associated with beta-thalassemia?

Answer 13

Chinese, Asian, Africain

Question 14

What ethnicities are associated with sickle cell disease?

Answer 14

African

Question 15

What ethnicities are affected by G6PD (glucose-6-phosphate dehydrogenase)?

Answer 15

Mediterranean or African descent

Question 16

What happens in G6PD (glucose-6-phosphate dehydrogenase)?

Answer 16

Lack of G6PD enzymes=RBC breakdown, especially during an infection or with oxidative drugs.

Question 17

What type of genetic inheritance is G6PD?

Answer 17

X-linked, affecting mostly males.

Question 18

What meds are contraindicated in G6PD individuals?

Answer 18

Sulfa, nitrofurantoin (macrobid), NSAIDS, touidine blue and methylene blue, fava beans, and some legumes.

Question 19

Which type of genetic inheritance is Von Willebrand’s disease?

A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked

Answer 19

C. Autosomal Dominant.

Question 20

Which type of genetic inheritance is sickle cell disease?

A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked

Answer 20

B. Autosomal Recessive

Question 21

Which type of genetic inheritance is thalassemia disease?

A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked

Answer 21

B. Autosomal Recessive

Question 22

Which type of genetic inheritance is G6PD disease?

A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked

Answer 22

A. X-linked

Question 23

What is the mechanism of Von Willebrand’s Disease and what condition is it associated with?

Answer 23

Defects in the protein needed for platelet adhesion, effecting clotting factor VIII. Causes heavy menses (20% of cases)

Question 24

What labs would you order to diagnose Von Willebrand’s Disease?

Answer 24

1. Platelets (normal)
2. Ferritin (low)
3. Coagulation (prolonged)

Question 25

What is the lifespan of a WBC?

Answer 25

10 days

Question 26

What are the sx of thrombocytopenia?

Answer 26

1. heavy menstrual bleeding 2. fatigue 3. easily bruised 4. enlarged spleen

Question 27

What are the causes of thrombocytopenia?

Answer 27

1. Meds - NSAIDS, statins, PCN, sulfonamides, chemo 2. Environmental 3. Excessive alcohol 4. Autoimmune Dz 5. Cancers 6. Splenic retention - infection, tumors

Question 28

What stage of hypertension is a BP of 134/81?

Answer 28

Stage 1 HTN

Question 29

What stage of hypertension is a BP of 156/107

Answer 29

Stage 2 HTN

Question 30

What labs need to be done for hypertension?

Answer 30

1. fasting blood sugar 2. thyroid 3. serum creatinine 4. lipid profile 5. serum Na, K, Ca

Question 31

Lifestyle changes recommended for primary hypertension

Answer 31

1. weight loss 2. low sodium diet <2400 mg/day 3. exercise 4. smoking cessation 5. moderate alcohol consumption

Question 32

First-line med management for primary hypertension?

Answer 32

Low-dose thiazide diuretic.

Question 33

What level of LDL-C would you prescribe a maximally tolerated statin (ex: high dose atorvastatin or rosuvastatin)?

Answer 33

LDL-C = >190 mg/dL

Question 34

What level of LDL-C would you prescribe a moderate-intensity statin (ex: lower dose atorvastatin, rosuvastatin, simvastatin)?

Answer 34

LDL-C = 70-189 mg/dL and 40-75 years with diabetes

Question 35

What level of LDL-C would you prescribe a low-intensity statin (ex: lovastatin or pravastatin)?

Answer 35

1. LDL-C = 70-189 mg/dL and 40-75 years WITHOUT diabetes OR 2. 10-year risk score >7.5%

Question 36

What is a safe pharmacologic treatment for rhinorrhea, sneezing, and congestion?

Answer 36

Ipratropium bromide (Atrovent) nasal spray. 2 sprays in each nostril 3-4xday

Question 37

What Abx can you prescribe for rhinosinusitis (sinus infection)?

Answer 37

1. amoxicillin or ampicillin/clavulanate 2. doxycycline (PCN alternative) 3. Clindamycin/cefixime or cefpodoxime

Question 38

What Abx can you prescribe for pharyngitis caused by GAS (group A beta-hemolytic Streptococcus)?

Answer 38

1. amoxicillin OR penicillin - 10 days 2. Clindamycin OR clarithromycin OR azithromycin (PCN alternative)

Question 39

What can be prescribed for bronchitis?

Answer 39

1. albuterol inhaler for relief or cough and wheezing (2 puffs q 4-6 hrs)

Question 40

What is the recommended therapy for pertussis?

Answer 40

Macrolide Abx-Erythromycin, azithromycin, or clarithromycin. Can prescribe prophylaxis for those in close contact.

Question 41

What do you prescribe for asthma if there are mild symptoms (occurring <2 days/week and <2 nighttime wakening/month)

Answer 41

Albuterol sulfate (Proventil) as needed.

Question 42

When would you prescribe omeprazole for an 8-week cours?

Answer 42

GERD treatment or diagnosis

Question 43

When would you prescribe triple therapy of a PPI, clarithromycin and amoxicillin for 14 days?

Answer 43

Peptic ulcers caused by H. pylori.

Question 44

What is the name of an infection ascending to the kidneys that has fever, flank pain with bacteriuria?

Answer 44

pyelonephritis

Question 45

When is a UTI labeled as "recurrent UTI"

Answer 45

2 episodes of acute bacterial cystitis (pos. cultures) within 6 months. OR 3 episodes in 12 months.

Question 46

What is the recommended first-line treatment for an uncomplicated lower UTI?

Answer 46

1. nitrofurantoin (Macrodantin) OR nitrofurantoin monohydrate with macrocrystals (Macrobid) 2. phenazopyridine HCl (Pyridium) 200 mg 3xday for 48 hours

Question 47

What is the second and third-line treatments for a UTI/pyelonephritis?

Answer 47

1. TMP-SMX (trimethoprim-sulfamethoxazole=Bactrim) 2. (serious infection) Augmentin, fluroquinolones, or beta-lactams

Question 48

What are the criteria for metabolic syndrome?

Answer 48

1. waist circumference >88cm women 2. triglycerides >150 mg/dL 3. HDL-C <50 mg/dL 4. BP >130/85 5. fasting glucose >110 mg/dL

Question 49

What is diagnostic for diabetes?

Answer 49

1. HA1c >6.5% 2. Fasting >126 mg/dL 3. 2 hr/75g >200 mg/dL

Question 50

What should the starting dose be for thyroid hormones for a newly diagnosed hypothyroidism?

Answer 50

50 mcg/day, recheck in 4-6 weeks, increase until euthyroid state is achieved.

Question 51

What is the initial treatment for carpal tunnel?

Answer 51

Splinting at night.